A Smaller Target

About Plastic Surgery

Weight 168

A few people have written me recently and asked me some questions about plastic surgery in general and mine specifically.  It made me realize I wrote quite a bit about my recovery in the early stages, but a lot less lately.  I've also had a few emails that have made me question my somewhat negative attitude about my plastics, both pre and post-op. 

So, here are some thoughts.   Please feel free to share your own, whatever they are.  Honestly, you won't offend me!

• I chose my surgeon after interviewing only one.  I had plans to speak to a few others, but I really really connected with this surgeon, Dr. Soo, plus the fact she was at USC Hospital where I had 90% insurance coverage, added to Dr. Kaufman being able to do my hernia repair at the same time, made me decide she was the one after our first meeting.

• In some ways I don't think I was emotionally ready for this surgery.  It all happened pretty quickly and relatively soon after my weight loss.  Though my weight had been stable for six months, I don't think I'd really gotten used to the changes in my body.  Had I not needed a hernia repair, I don't think I would have had plastic surgery when I did.  This probably has contributed to my somewhat negative attitude toward the surgery, despite the fact I've had no complications, have healed better than anyone expected and have very nice looking results.  I still resent a lot about the surgery itself, about the time needed to recover, the pain and the limitations having a healing incision 2/3 around my lower abs and from pubis to breast bone is bound to cause.  I can't help it, I hate and resent them.  That this was just the first of what will likely be 3 - 5 rounds of surgery leaves me filled with a sense of despair at the loss of control and the stealing of time each surgery means.

• Yes, I know that I'm fortunate in my insurance coverage and that there are many many post-ops who've wanted plastics for years and have no coverage for them and / or cannot afford them.  Knowing that does temper how often I complain(ed) about how much having to have surgery over the winter holidays sucked.  But there is another side to this.  One reason that my insurance was so quick to cover skin removal for me is that I have profound skin problems pre-dating my weight loss.  Rather than being made better by losing weight (as I was repeatedly told would happen pre-op) the excess skin has contributed to worsening eczema and skin breakdown.  In addition to being unsightly, these rashes and open sores are very very painful (think burning insects under the skin) and have been pretty much on-goingly hellish for eight years.  It's hard to feel grateful for them, however much they may contribute to having coverage for plastics.  After all, they're also responsible for these having to be done as individual surgeries rather than combining them.  My skin most likely can't handle the stress of healing multiple wound sites.

•   The results.  Losing Fred (my pannus) has made a real difference in how I look.  A month ago I thought the swelling had gone, but even from last month to this I can see a real difference.  I've been told that the swelling will probably be there for another 2-4 months and that only in June or so will I have a real idea of the result.  But to my eye it already looks great.  Losing Fred does highlight a bit how much my thighs and bum sag, but I don't really care about that -- I'm still glad that Dr. Soo didn't do the lower body lift.  That side will get taken care of eventually.

• Was the recovery hard?  In a word, yes.    Much moreso than my DS surgery, especially for the first month post-op.  Examples?  Post-DS I was able to sleep in my own bed with my husband from day one after being released from the hospital.  After the tummy tuck, hernia repair, it was more than a month before I could sleep in our bed or even lie down on my side for more than 10 - 15 minutes.  I had to sleep in a recliner.  Sexual contact was also out during that entire time, despite our anniversary being during my recovery.

• Depression.  Yes, this happened.  The combination of the pain meds, different sleeping position, loss of working-out and my asthma also contributed to panic attacks.  I had bouts of the blues where it was really hard to do anything.  This was made worse by the fact I can't read when I'm on vicodine and reading is my major escape when I need comfort.

People write a lot about the costs of plastic surgery, talking about the financial side and / or the pain.  And those are really real, of course.  But for me, the biggest cost is time.  I feel like my weight made me live on the sidelines of life for way too long already.  I hate feeling put back there for any reason.

So there you have it.  My post-op thoughts almost two months away from the surgeries.  I did take pictures pre and post-op and will get around to putting them up, probably behind a password, sometime in the next month.

A New Surgeon?

Yesterday I had a surgery (remember the hernia repair) follow-up with Dr. Kaufman.  It was a bit sad as I found out the rumor I'd heard is true.  He's returning to his original area of practice (colon / rectal surgery and pelvic floor disorder) and no long taking weight loss surgery patients.  I was told that he was going to be referring his long term patients to a newly hired associate, Dr. Nahid Hamoui, who I would have met but is currently out on maternity leave.  When I told him I'd miss seeing him, he said he was going to keep the same clinic days as her and I was welcome to come and see him too.

Much as it's true -- I am going to miss him -- I'm also really excited about the new surgeon.  Why?  This probably sounds sexist (and it's certainly not that I haven't had great male doctors) but given a choice I prefer seeing female doctors to male ones.  I think it's because while I've had some great male doctors, a couple of whom literally saved my life during asthma attacks, I've also had some pretty bad experiences with some bad male doctors over the years.  One who was just inexperienced and hurt me (assuming I was sexually active when I wasn't yet and thus "popping my cherry" during pelvic exam) and more than a couple of whom basically threw up their hands and gave me the "maybe if you lost weight" line about severe eczema that was literally driving me insane via insomnia and pain. 

By contrast, though about half of my treatment has come from female doctors (as I said, I tend to choose them if I can), I've never had a bad one, never had one be anything less than a caring professional.  Come to think of it, never had one I didn't actively like, as in wish we could get together for coffee or lunch.  Case in point is Dr. Chia Soo who just did my plastic surgery.  Not only did she do a beautiful job while I was under, but she was / is a pleasure to talk to.  I'm not saying that this wouldn't have been the case with a male surgeon too, but since the prep for surgery involved spending over an hour standing completely naked in front of her while she drew lines on my abdomen, I think her being another women made it easier for me.

So what did I do?  Last night I spend a couple of hours online and researched Dr. Hamoui.  What I found made me feel good.  Yes, she's a newly minted surgeon, however her training (at USC) was with both Dr. Crookes and Dr. Anthone, and indeed is listed as their co-author on most of their recent articles, and on articles where she is the first author, they are listed as her co-authors.  Her publications (that I found anyway) related mostly to VGS and duodenal switch surgeries, so I suspect her training and research focuses on the DS. 

All of this left me feeling really good.  I'm looking forward to meeting her in March.

Three Weeks Out: Good, Bad, Ugly

Reading the stunningly beautiful (my dad's comment on her reunion picture) Kim's account of her plastics recovery --Kim had a lower body lift (that's a tummy tuck and backside lift at the same time) and breast lift on December 12-- reminded me that I hadn't really updated about the plastics this week at three weeks out.   In case you need a refresher, here's my first week entry.

So here goes.

The Good:

• the swelling is going down -- I'm wearing size 14 today rather than the 16/18s I was wearing last week.  My weight has dropped more than 10 pounds (190 to 178) almost back to where it was pre-op so a lot of the water must be gone.  This still doesn't take into account the 6 pounds of skin that was removed.  Maybe by next week.
• the drains are ALL out.  Thank you God.
• places on my body are visible now that I can only remember seeing in mirrors.
• pain pills are spaced out 6 - 12 hours rather than me staring at the clock waiting for it to be 4 hours. 
• the lipo-in-a-box is WAY more comfortable than the hospital binder. 
• the incision is healing nicely as are all the drain holes.  There is (currently anyway) no drainage or leakage.
• belly button is looking pretty good and healing very nicely.
• vertical incision is already a skinny pink line. 
• having to sit in a comfy chair so much has allowed lots of time for blogging.  Can't speak to the quality, but there's plenty of quantity.  I still can't focus enough to read any thing but novels by Terry Pratchett.  And that's only because I've read them about 10 each already.
• as time goes on, I can see that I really do have something that looks like a waist now.  Wow!

The Bad:

• there is still a good deal of muscle pain, especially when I've gone more than 8 hours without the pain meds.
• feh!  I have a cold.  Lovely.
• asking for help is still every bit as annoying.  I feel like I'm being lazy, especially as I see things that need to be done around my parents' house.
• this has NOT helped my constipation issues.  Even with all the extra coffee and tea.
• My hips and thighs look huge.  Probably because they are, but still.  Wow.  Especially when the binder has my breasts completely flat.
• still sleeping in a chair.  Do keep in mind too that I slept in our bed as soon as I got out of the hospital after my DS.  That's how much worse this has been.

The Ugly:

• panic attacks.  These are so not fun.  The ambien that my surgeon's given me has helped, but they're still happening at night and I'm scared that they're going to become a more common feature of my post-op life.  And, also annoying and probably related, I've become something of an emotional basket case.  Poor Paul!
• the curved spine thing is getting annoying.  I can't believe I have another week of it to go before I'm supposed to even try straightening.  Ack!
• after sneezing and coughing, a lump appeared just above where my old hernia was.  I'm terrified that the hernia somehow came back, though it might just be muscle swelling. 

All in all I know I'm really lucky to have gotten such great care.  And I'm recovering very well.  But man o man, this has been a lot harder physically then the recovery from the DS was.  It's made me feel miserable at the thought of the 3 - 4 additional surgeries I'm supposed to be planning for.  Aside from everything else, I really resent losing months of my life to this.  It's been three weeks and I'd say I'm still only at about 60% of full power. 

Scare

It seems I've caught a bit of a cold.  Runny nose, watery eyes and a cough.  The cough was what did me in.

Last night as I was sitting and watching Father Ted I started coughing.  There wasn't a pillow but I grabbed my chest.  But when I finished there was a small sore little bulge on the upper part of my incision line, just below my sternum.  Just exactly where my hernia was.  I can't even believe I might have done this to myself. 

I freaked out.  At first I didn't want to tell anyone, but then told my mom and Paul.  Paul calmed me down, pointing out that if it's a hernia, there's nothing more I can do anyway.  I've spent the day being very quiet with a pillow next to me in case I need to cough or sneeze.  The lump is smaller today, but still sore and swollen.  I'm going to be super careful from now on. If I haven't hurt myself yet, I'm going to make sure that I don't. 

Yes, I have been pushing too hard, trying to do too much too fast.  From here on out, I'm going to take it easier.  Much, much easier. 

But damn, I'm still really freaked out. 

It Finally Came!

Weight 180 (yay!)

So much for "priority mail express shipping." 

What with the Christmas rush and everything, the post office only today got around to delivering the high waisted capri support garment I ordered from Lipo in a Box back on the 14th.  Fortunately I haven't been stuck wearing my binder (ugh) the entire time.  My mom loaned me the pair she'd ordered from them. Still, it was good to finally get my own as hers wasn't one of the high waisted sort.

They're really quite comfortable.  Putting them on feels a lot like getting into pantyhose.  But once they're on they seem to support without the terrible hard pressure points that my binder gives.   And I love the way my legs look when I'm wearing it.  My thighs are actually smooth and firm. 

The swelling is definitely going down now at my waist and thighs (whew!).  And size 16s are loose again.  :)

More herbal tea say I!

Healing

Weight: 184

Yeah, despite the fact I've had enough herbal tea to float a boat in, I seem to be getting heavier.

Thanks Melody and Alison.  I can't tell you how much better your comments made me feel.  Logically I know that this is all swelling and water bloat, but post wls its so hard to see my weight and size go up like this.  Especially when I'm feeling terrible.

That's right.  Today I feel terrible. 

It's my own fault.  I overdid yesterday when I should have rested after having traveled and all that on Tuesday.  I spent all afternoon making cookies (sugar and gingerbread cut-outs) with my mom.  They came out wonderfully -- she did the rolling and cutting and I did the frosting and piping.  Then we made some platters for some friends of my parents.  Then Paul and I went shopping.  Just to Fred Meyers (grocery store) and then a quick roam around TJ Maxx; it felt like nothing.  But by the time I got home I felt tender and sore.  Taking a shower was the final straw -- it used up the last of my energy.   And, even though I had it a week before surgery, my body has decided that I should have my period  now  too.  Bah!

Today I went out with my mom in the morning to her day spa.  The owner, Jade, had given me a facial and pedicure before my DS surgery.  She was just stunned by my weight loss.  Sometimes it's hard to remember how dramatic it's been. She's planning on getting a tummy tuck of her own in a couple months so wanted to know what it was like.  I felt bad, but said that, right now, it mostly seemed painful.  While Jade waxed my mom in another room,  I just sat and had a warm aromatherapy treatment on my neck and read Vogue and In Style.  It was great.   Jade gave me a bunch of facial treatment products that she thinks will help with the eczema on my face.  I'm going to try them this week and get back to her.  It would be cool, but I've tried so much so many times I can't get my hopes up too much.

Other than that outing, I've spent most of the day sitting with my feet up watching TiVo.  I've got a scary sharp pain in my abs that feels like I'm trying to tighten them even though I'm not.   It's gotten better throughout the day, but has scared me enough that I'm  definitely taking it easier.

What I'm Wearing Post-Op

When I woke up in the hospital, I was wearing one of the stylish and a layer of thick padding under an elastic binder.  The binder was 18 inches wide by 48 inches long (unstretched).  It had a couple of supportive stays and was held together by a wide strip of velcro. 

Obviously I'm not wearing any of that right now.  Any of that EXCEPT the binder.  At the suggestion of Dr. Regina Kim, I cut the binder down to fit me better.  It's now about 12 inches wide by 34 inches long.  It's not comfortable or anything, but at least fits me a little.  I hate it.  It causes two constant problems.  One is that while it's supportive, it's also firm enough to make my skin feel sore just from the pressure of its edges and it's rough enough that I need to keep it from touching my skin.  So I'm wearing a lot of layers.  Here they are in order...

Day: 

1. soft cotton panties that are large enough that their elastic lays above my incision line
2. Norm Thompson cotton cami with built-in underwire bra
3. binder
4. slacks or jeans
5. long sleeved tee shirt and / or sweater

The cotton cami's have been life-savers.  They're soft and keep the binder away from my skin and cut down a layer (otherwise I'd need to wear a bra and tank top). 

Night:

1. soft cotton panties that are large enough that their elastic lays above my incision line
2. long sleeved silk undershirt
3. binder
4. pajama pants (mostly drawstring flannel)
5. long sleeved thermal undershirt

I've ordered a high waisted capri length support garment from Lipo In A Box.  Once it comes, I won't need to wear the binder anymore during the day.  I haven't purchased anything from them before, but my mom, sister and cousin (okay, cousin-in-law) have all bought different things and rave about them, especially the bottoms.  What seems pretty extraordinary about that is that they're all very different sizes and wear them for different reasons. 

My cousin-in-law is petite and small, probably a size 4-6.  She's had 3 kids and wears their high waisted stuff to hold in her "cupcake".  My mom wears the capris under pants to smooth and lift and also has bought a body suit which she says is amazingly comfortable.  Eloise (my sister, an RnY post-op) wears the capri length support garment for exercising.  She says it holds her legs well enough to allow her to run / jog, something excess skin wouldn't allow her to do otherwise. 

All say that the garments are light, cool and comfortable.  None of which can be said about my binder!

Hope mine arrives today!

Water, Water Everywhere

Weight: 182

Post plastic surgery, I left the hospital with a lot of water / swelling.  How much?  I'm not sure.  But....

• enough that I went into the hospital wearing a size 10-12  in jeans; even now I can barely get on my size 16 jeans.  The 18s fit comfortably.
• my thighs were so swollen they were rock hard with no jiggling or hanging skin. This was not the case pre-op, trust me.  My legs also measured 2 inches larger around at the knees and thighs.
• Pre-op, my weight was ~178.  Dr. Soo removed almost 6 pounds.  I didn't have a scale when I got home, but three days ago I stepped on a scale and weighed 187.  That's almost 10 pounds heavier then I was before plastics.

I know this isn't real weight gain.  Aside from anything else, I haven't been able to eat very much since surgery and have eaten very little sugar.  I also know nothing but time and healing will reduce the swelling.  But I want to get all this excess water off me.  Being at my parents' house with a scale gives me a good chance to keep track of how

For the past 4 days I've been drinking a lot of herbal tea (I'm too cold to drink much water) and trying to walk as much as possible to get the water out of my legs.  Given the amount of time I've spent in the bathroom, I think it's working.  This morning I weigh 182 on my mom's scale. 

If you've had this sort of post-op water retention, how long did it take to leave your body?  And what did you do to get it out? 

They're Out!

The PA at Dr. Soo's office decided yesterday that she could yank both my remaining drains.  That's four drains gone!  Sooo happy.  I had no idea how much the drains were making me feel gross and icky until they were gone.  Now to ditch the binder ASAP....

Getting them out also means I was cleared to fly to Portland this morning.  We're on a 6.50 am flight.  Christmas here I come!

Yesterday was also very cool because I got a chance to meet two wonderful pre-ops before my appointment (they were going to see Dr. Crookes).  Leslie, who I'd met before and is always awesome to see and Sandy, who I met for the first time and is the most amazing lady.  God only knows what they thought of me as because of the drugs I chattered non-stop for 45 minutes, but they felt like old friends I was seeing after too long.

And then I got to meet two grad school friends for tofu soup.  Mmmm...

It felt so good to have a busy day after so long just sitting in the chair.

Another Day

Another post-op day spent "recovering" --something which largely consists of napping on a comfy chair, trying to remember to eat (did I mention that my desire for food has been quite low since surgery?) and counting the hours between doses of pain medication.   If I haven't been blogging much, it's basically because I'm rather bored with my life and so feel guilty writing about it it here and thus spreading the boring around.

Someone did save me, however by writing and asking a few questions.  I can't really call them "frequently asked" but hey, any port in a storm. 

So here's the first of a few questions and their answers:

I used to read your comments and things on some of wls forums.  How come you don't post there anymore?

When I was pre-op and in the early days post-op, I was a very active poster on both the forum on the duodenal switch website (highly recommend this community) and also on the DS part of the Obesity Help site (reservation there).  I've disappeared from both over the last several months for different reasons. 

Since I can be frank here --my blog, my thoughts, my rules and no I won't delete your comments either...  There are wonderful people who participate on the DS board on the Obesity Help site.  I miss them.  However, the way OH runs their forums represents (to me) the worst in Internet forum management.  They tend to censor / delete that which they don't want to read / hear, are arbitrary in the enforcement of rules and allow a vocal (and overly-"Christian"* oriented) minority have sway over everyone else.  Basically they create a world that encourages adults to act like children.  The DS board tends to be relatively free of this, but in my experience, it does spill over from the main forum every few months.  I'm very attached to my words, be they clever or not, and I don't like the idea of anyone but me having the right to delete them.  So when Obesity Help started censoring a regular poster on the DS forum, I stopped reading and posting there.

The exact opposite management style can be found, btw, on the Duodenal Switch website.  The manager there (Melanie) generally only deletes post / entries at the request of their authors and goes out of her way to be fair and allow conflicts to work themselves out.  I stopped posting and reading regularly there when life got so complicated this summer.  It's always been my intention to come back there, though I felt kind of bad doing it right before my tummy tuck, I guess because I thought it would seem like I was fishing for sympathy.

A final point is a structure thing.  I like the way that topics stay current (that is on the first page) of the Duodenal Switch site so long as they are actively being discussed.  It was always annoying to have to page back to discussions on the OH site forums even if the discussions were still actively engaged.

--
*I put "Christian" in quotation marks because my experience of them wasn't of Christianity as I know it, but rather of the worst sort of mean-spirited hypocrisy cloaking itself under the name "Christian"